New York City Lead-Based Paint Disclosure
Property Information
Property Address
Unit #
Borough
Lessor Information
Name
Address
Phone
Email
Lessee Information
Name(s)
Phone
Email
Disclosure
This property was built before 1978.
Lessor has knowledge of lead-based paint or hazards present in the property.
If yes, describe the location and condition:
Lessor has reports or records regarding lead-based paint.
If yes, list and provide copies:
Lessee Acknowledgment
Lessee has received the pamphlet "Protect Your Family from Lead in Your Home."
Lessee has received reports and records listed above.
Certification of Accuracy
Lessor Signature
Date
Lessee Signature
Date